Revision of NICE guidelines on diabetes

[desidiabulum]

I don’t know whether anyone realised, but tomorrow (Wednesday 29th) is the last day of the consultation period regarding the scope of the revised NICE clinical guidelineson diabetes (Type 1 Diabetes, Type 2 Diabetes, Diabetes in Children and Diabetes in Pregnancy) for use by the NHS in England, Wales and Northern Ireland.
The development of the guideline recommendations will begin in October 2012.
Areas where guidelines will be updated for Type 2 include
1. Target values for blood glucose control. This includes: HbA1c [currently 7.5], fasting blood glucose, post-prandial blood glucose, oral glucose tolerance.
2. The effectiveness of self monitoring of blood-glucose levels for blood-glucose control.

Issues up for review do not include dietary advice.

Review questions include:
1. Pharmacological management of blood glucose levels
What pharmacological interventions should be used to control blood glucose levels in people with type 2 diabetes? When should pharmacological interventions be used?
What are the long-term safety issues associated with the use of pharmacological interventions to control blood glucose in people with type 2 diabetes?

2. Target values for glucose control
What are the optimal target values for HbA1c, fasting blood glucose, post-prandial blood glucose and oral glucose tolerance in people with type 2 diabetes?

3. Self monitoring of plasma glucose
Should self monitoring be used to control blood glucose levels in people with type 2 diabetes?

A further issue flagged in the review questions is:
Economic aspects
Developers will take into account both clinical and cost effectiveness when making recommendations involving a choice between alternative interventions. A review of the economic evidence will be conducted and analyses will be carried out as appropriate. The preferred unit of effectiveness is the quality-adjusted life year (QALY), and the costs considered will usually be only from an NHS and personal social services (PSS) perspective. Further detail on the methods can be found in 'The guidelines manual'.

Comments on the NICE draft consultations can only be made from a registered stakeholder organization. Stakeholders can include ‘national patient and carer organisations that directly or indirectly represent the interests of people whose care is covered by the guideline (‘patient and carer stakeholders')’ – this stakeholder list therefore includes Diabetes UK (but not DCUK). If anyone is a member of one of the stakeholder organizations (which for T2 include Age UK, Diabetes Management and Education Group, Coeliac UK, Hindu Council UK and the Expert Patients Programme, and a number of universities) they might want to try to have some input.

 

[viviennem]

Thanks for that. I think another email to my MP is called for - as a Type 2 diabetic I consider myself a stakeholder! Why don't they want input from people who actually have the condition and who can speak from experience?!

Viv 8)

 

[desidiabulum]

Good point Viv. I have a couple of contacts in NICE and am raising this issue with them. I think the revised NICE guidelines are going to be *the* crucial battleground on testing trips and BG/hba1c targets (forget the e-petition! -- I'm sorry, but one has to be realistic), and as Mary's MP showed this is what will be cited back at us in the future. The deadline for discussing the SCOPE of the review passes today, but consultations on the guidelines themselves begin in October, so there is still something to play for.
I am appending the list of stakeholder organizations for the Type 2 debate below (sorry it's so long). Anyone involved in them can make an input (so anyone who is a member of DUK, or any of the universities listed).
A.Menarini Pharma U.K. S.R.L.
Abbott Healthcare Products Ltd
Adults Strategy and Commissioning Unit
Advisory Committee for Community Dentistry
African HIV Policy Network
Age UK
Alder Hey Children's NHS Foundation Trust
Alere
Allergan Ltd UK
AMORE Studies Group
Anglian Community Enterprise
Ark Therapeutics Ltd
Arrowe Park Hospital
Association for Continence Advice
Association for Improvements in the Maternity Services
Association for the Study of Obesity
Association of Anaesthetists of Great Britain and Ireland
Association of British Clinical Diabetologists
Association of British Dispensing
Association of British Healthcare Industries
Association of Children’s Diabetes Clinicians
Association of Clinical Pathologists
Association of Optometrists
Astrazeneca UK Ltd
B. Braun Medical Ltd
Barnet Enfield and Haringey Mental Health Trust
Barnsley Hospital NHS Foundation Trust
Barnsley Primary Care Trust
Basildon and Thurrock University Hospitals NHS Foundation Trust
Baxter Healthcare
Bayer HealthCare
Bayer plc
Bedfordshire Primary Care Trust
Betsi cadwaladr
Black and Ethnic Minority Diabetes Association
Black Country Partnership Foundation Trust
Blood Pressure Association
Boehringer Ingelheim
Bolton Primary Care Trust
Bradford and Airedale Primary Care Trust
Bradford District Care Trust
Breakspear Medical Group Ltd
Bristol PCT
Bristol-Myers Squibb Pharmaceuticals Ltd
British and Irish Orthoptic Society
British Association for Counselling and Psychotherapy
British Association of Prosthetists & Orthotists
British Association of Social Workers
British Dietetic Association
British Geriatrics Society
British Heart Foundation
British Hypertension Society
British Infection Association
British Medical Association
British Medical Journal
British National Formulary
British Nuclear Cardiology Society
British Nuclear Medicine Society
British Nutrition Foundation
British Obesity Surgery Society
British Pain Society
British Paramedic Association
British Psychological Society
British Renal Society
British Society for Human Genetics
British Society for Paediatric Endocrinology and Diabetes
British Society for Sexual Medicine
British Society of Interventional Radiology
British Society of Periodontology
Buckinghamshire Primary Care Trust
BUPA Foundation
Calderdale Primary Care Trust
Cambridge University Hospitals NHS Foundation Trust
Camden Link
Camden Provider Services
Capsulation PPS
Capsulation PPS
Cardiff Research Consortium
Cardiff University
Care Quality Commission (CQC)
Central Lancashire Primary Care Trust
Central London Community Healthcare
Chartered Society of Physiotherapy
Cheshire and Merseyside Cardiac Network
Chester-le-Street Community Hospital
CHKS Ltd
CIS' ters
City and Hackney Teaching Primary Care Trust
Coeliac UK
Commission for Social Care Inspection
Community Diabetes Consultants
Community Practitioners' & Health Visitors Association
Cook Medical Inc.
Countess of Chester Hospital NHS Foundation Trust
County Durham Primary Care Trust
Coventry and Warwickshire Cardiac Network
Covidien Ltd.
Cygnet Hospital Harrow
Daiichi Sankyo UK
David Lewis Centre, The
Department for Communities and Local Government
Department of Epidemiology and Public Health
Department of Health
Department of Health, Social Services and Public Safety - Northern Ireland
Derbyshire County Primary Care Trust
Derbyshire Mental Health Services NHS Trust
Det Norske Veritas - NHSLA Schemes
Diabetes Management and Education Group
Diabetes UK
Diet Plate Ltd, The
Diving Diseases Research Centre, The
DJO UK Ltd
Doctors Support Network
Dudley Primary Care Trust
Durham and Chester Primary Care Trust Podiatry Department
East and North Hertfordshire NHS Trust
Education for Health
Elcena Jeffers Foundation
Eli Lilly and Company
Equalities National Council
Essex Cardiac & Stroke Network
ESyDoc
Expert Patients Programme CIC
Experts in Severe and Complex Obesity
Faculty of Dental Surgery
Faculty of Pharmaceutical Medicine
Faculty of Public Health
Faculty of Sport and Exercise Medicine
Federation of Ophthalmic and Dispensing Opticians
Ferring Pharmaceuticals
Food Advertising Unit
Food for the Brain Foundation
George Eliot Hospital NHS Trust
GlaxoSmithKline
Gloucestershire LINk
Great Western Hospitals NHS Foundation Trust
Greater Manchester West Mental Health NHS Foundation Trust
Grunenthal Ltd
Guy's and St Thomas' NHS Foundation Trust
Halton & St. Helens Primary Care Trust
Hammersmith and Fulham Primary Care Trust
Hampshire Partnership NHS Trust
Harrogate and District NHS Foundation Trust
Havering Primary Care Trust
Healing Honey International Ltd
Health and Safety Executive
Health Protection Agency
Health Quality Improvement Partnership
Healthcare Improvement Scotland
Heart of England NHS Foundation Trust
Heart of Mersey
HEART UK
Hertfordshire Partnership NHS Trust
Hindu Council UK
Humber NHS Foundation Trust
Independent Healthcare Advisory Services
InferMed
Innovation Rehab
Institute of Biomedical Science
Institute of Physics and Engineering in Medicine
Insulin Dependent Diabetes Trust
Integrity Care Services Ltd.
International Glaucoma Association
Janssen
Johnson & Johnson
Johnson & Johnson Medical Ltd
karimahs cuisina
KasTech Ltd
KCI Europe Holding B.V.
KCI Medical Ltd
Kidney Alliance
King's College Hospital NHS Foundation Trust
Kingston Hospital
Knowsley Primary Care Trust
L.IN.C.Medical
Lancashire Care NHS Foundation Trust
Launch Diagnostics
Leeds Community Healthcare NHS Trust
Leeds Primary Care Trust (aka NHS Leeds)
Leeds Teaching Hospitals NHS Trust
Leicestershire, Northamptonshire and Rutland Cancer Network
Lesbian, gay, bisexual and trans domestic abuse forum
LifeScan
Lilly UK
Liverpool Primary Care Trust
Liverpool Women's NHS Foundation Trust
Lloyds Pharmacy
Luton and Dunstable Hospital NHS Trust
Maidstone and Tunbridge Wells NHS Trust
Maidstone Hospital
Manchester Metropolitan University
Maternity and Health Links
McCallan Group, The
Medicines and Healthcare products Regulatory Agency
Medway Community Centre
Mental Health Act Commission
Merck Serono
Merck Sharp & Dohme UK Ltd
Ministry of Defence
Molnlycke Health Care Ltd
MSD Ltd
National Council for Palliative Care
National Diabetes Nurse Consultant Group
National Heart Forum
National Institute for Health Research Health Technology Assessment Programme
National Obesity Forum
National Patient Safety Agency
National Pharmacy Association
National Prescribing Centre
National Public Health Service for Wales
National Treatment Agency for Substance Misuse
NDR UK
NHS Blood and Transplant
NHS Bournemouth and Poole
NHS Clinical Knowledge Summaries
NHS Connecting for Health
NHS Cornwall and Isles Of Scilly
NHS Devon
NHS Direct
NHS Kirklees
NHS Milton Keynes
NHS Nottingham City
NHS Nottinghamshire County
NHS Plus
NHS Plymouth
NHS Sefton
NHS Sheffield
NHS Trafford
NHS Warwickshire Primary Care Trust
NHS Yorkshire and the Humber Strategic Health Authority
North Cheshire Hospitals NHS Trust
North East London Community Services
North East Yorkshire and Northern Lincolnshire Cardiac & Stroke Network
North Essex Mental Health Partnership Trust
North Staffordshire Primary Care Trust
North Tees and Hartlepool NHS Foundation Trust
North West London Hospitals NHS Trust
North Yorkshire & York Primary Care Trust
Northern Ireland Chest, Heart & Stroke
Northumbria Diabetes Service
Northumbria Healthcare NHS Foundation Trust
Nottinghamshire Healthcare NHS Trust
Nova Biomedical UK
Novartis Pharmaceuticals
Novo Nordisk Ltd
Nutrition and Diet Resources UK
Obesity Management Association
OPED UK Ltd
Optical Confederation, The
OSI Pharmaceuticals
Owen Mumford Ltd
Oxford Nutrition Ltd
Oxleas NHS Foundation Trust
Pancreatic Cancer UK
Patient Assembly
PERIGON Healthcare Ltd
Peterborough City Hospital
Pfizer
Pharmametrics GmbH
Powys Local Health Board
Primary Care Cardiovascular Society
Primary Care Diabetes Society
Primary Care Pharmacists Association
ProStrakan Group
Public Health Agency
Public Health Wales NHS Trust
Queen Elizabeth Hospital
Queen Mary's Hospital NHS Trust
Rethink Mental Illness
RioMed Ltd.
Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust
Roche Diagnostics
Roche Products
Royal Berkshire NHS Foundation Trust
Royal Brompton Hospital & Harefield NHS Trust
Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of General Practitioners in Wales
Royal College of Midwives
Royal College of Nursing
Royal College of Obstetricians and Gynaecologists
Royal College of Ophthalmologists
Royal College of Paediatrics and Child Health
Royal College of Paediatrics and Child Health, Gastroenetrology, Hepatology and Nutrition
Royal College of Pathologists
Royal College of Physicians
Royal College of Physicians of Edinburgh
Royal College of Psychiatrists
Royal College of Psychiatrists in Wales
Royal College of Radiologists
Royal College of Surgeons of England
Royal Cornwall Hospitals NHS Trust
Royal National Institute of Blind People
Royal Pharmaceutical Society
Royal Society of Medicine
Royal Surrey County Hospital NHS Trust
Royal United Hospital Bath NHS Trust
Rupanyup Hospital/Nursing Home
Sanctuary Care
Sandwell and West Birmingham Hospitals NHS Trust
Sandwell Primary Care Trust
Sankyo Pharma U K Ltd.
Sanofi
Scarborough and North Yorkshire Healthcare NHS Trust
SCHOOL AND PUBLIC HEALTH NURSES ASSOCIATION
Scottish Intercollegiate Guidelines Network
Scottish Oral Health Group
Sebia
Servier Laboratories Ltd
Sexual Advice Association
Sheffield Childrens Hospital
Sheffield Primary Care Trust
Sheffield Teaching Hospitals NHS Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
Slimming World
SNDRi
Social Care Institute for Excellence
Society and College of Radiographers
Society of District General Hospital Nephrologists
Society Of Vascular Nurses
Solihull NHS Primary Care Trust
Solvay
South Asian Health Foundation
South East Coast Ambulance Service
South East London Cardiac Network
South London & Maudsley NHS Trust
South Staffordshire Primary Care Trust
South Warwickshire NHS Foundation Trust
South West Yorkshire Partnership NHS Foundation Trust
Southend Hospitals NHS Foundation Trust
Southern Alliance of Tissue Viability Nurses
Southern Health & Social Care Trust
Sport England
Stockton-on-Tees Teaching Primary Care Trust
Swansea NHS Trust
Takeda UK Ltd
Tameside Hospital NHS Foundation Trust
Telemedcare Ltd
Teva UK
Thames Ambulance Service Ltd
The Association for Clinical Biochemistry
The Association of the British Pharmaceutical Industry
The British In Vitro Diagnostics Association
The National LGB&T Partnership
The Phoenix Partnership
The Prince’s Foundation for Integrated Health
The Rotherham NHS Foundation Trust
The University of Glamorgan
The Whittington Hospital NHS Trust
Tiny Tickers
Tunstall Healthcare UK Ltd
UK Anaemia
UK Clinical Pharmacy Association
UK National Screening Committee
UK Thalassaemia Society
University College London
University College London Hospital NHS Foundation Trust
University Hospital Aintree
University Hospital Birmingham NHS Foundation Trust
University of Huddersfield
University of Leeds
University of Nottingham
Vitaline Pharmaceuticals
Walsall Local Involvement Network
Walsall Teaching Primary Care Trust
Weight Concern
Welsh Endocrine and Diabetes Society
Welsh Endocrinology and Diabetes Society
Welsh Government
Welsh Scientific Advisory Committee
West Hertfordshire Primary Care Trust
West Herts Hospitals NHS Trust
West London Mental Health NHS Trust
West Middlesex University Hospital NHS Trust

 

[Unbeliever]

Thanks for that. I think another email to my MP is called for - as a Type 2 diabetic I consider myself a stakeholder! Why don't they want input from people who actually have the condition and who can speak from experience?!

Viv 8)

Its quite amusing to think of some of those who could have a say in our diabetes treatment while having no apparent interest in it.
I am a member of 2 organisations on the list. I might start offering my totally theoretical and uninformed opinions on all sorts of issues- just for fun. :lol:

 

[MaryJ]

thanks for that desidiabulum

What a list!

will check if I'm a member of any - first glance don't think so

seems absured all those organisations can have a say on how we should manage our diabetes.

Picked one at random purely cos I've never heard of them http://www.phoenixpartnership.co.uk/ errrrrrrrrrrrrrrrrrrrrrrrrrrrrrr?????????? am i missing something?

Mary x

 

[BioHaZarD]

That list has some weird entries like mention phenolic? Slimmingworld, lesbian and gay, bisexual and trans abuse? Really?

 

[catherinecherub]

thanks for that desidiabulum

What a list!

will check if I'm a member of any - first glance don't think so

seems absured all those organisations can have a say on how we should manage our diabetes.

Picked one at random purely cos I've never heard of them http://www.phoenixpartnership.co.uk/ errrrrrrrrrrrrrrrrrrrrrrrrrrrrrr?????????? am i missing something?

Mary x

This organization is used in professional supervision, skills training, humanistic psychology.
These types of organizations are often employed within the NHS in staff training programmes. They are probably involved with the training of Health Care Professionals specialising in Diabetes.

 

[catherinecherub]

That list has some weird entries like mention phenolic? Slimmingworld, lesbian and gay, bisexual and trans abuse? Really?

Slimming World has members who are diabetics. Could be they are interested in the results of this type of weight management? G.P.'s might decide to meet some of the cost as a way forward.

As for LGB@T. There is a high incidence of Type2 in people using prescribed drugs for HIV treatment, (a bit like steroid induced that some members here have). HIV medicines are for life. We know what the depression can be like following a diagnosis of diabetes. HIV causes deep depression in some people and I would think that adding diabetes must be really hard. It is probably all about getting the best professional help which may have to come from the diabetes budget in part. I would think that their representatives are involved to understand the latest advice about treatments and guidelines and put forward their findings to date..

It was interesting to note that the issues up for review do not include dietary advice.

 

[BioHaZarD]

Slimming World has members who are diabetics. Could be they are interested in the results of this type of weight management? G.P.'s might decide to meet some of the cost as a way forward.

I have spoken to a few diabetic slimmingworld members as I am still a member if the online forums. Most tend to eat as is (including pasta, rice etc) and speaking to 1 of them yesterday he eats about 6 or more portionso of fruit a day including bananas, apples, etc, etc. And he is on 2 x Metformin only (down from 4) and has lost 4.5 stone.

I just could not eat that amount.

 

[Etty]

Amazing how few of the organizations listed actually have the word Diabetes in their name. I don't understand why DCUK isn't in there.

 

[Sid Bonkers]

Thanks for that. I think another email to my MP is called for - as a Type 2 diabetic I consider myself a stakeholder! Why don't they want input from people who actually have the condition and who can speak from experience?!

Viv 8)

Err they do Viv, last year I attended a seminar seeking the views on diabetes treatment from, yes youve guest it, diabetics. I beleive they held similar seminars up and down the country, didnt Ladybird attend one? At the end of the seminar I was handed a leaflet called Diabetes Voices which I was asked to join, as yet I have not but it is there and if you wish your views to be heard then you are free to join.


In fact only last week I received this email:

Dear $id,

I hope you are well. I am contacting you because I thought you might be interested in coming along to a group discussion about cardiovascular disease (CVD) and diabetes. We want to talk to people who have type 2 diabetes and manage their diabetes with either tablets or insulin (or a combination of both).

NHS Diabetes wants to develop some practical tools that would help you self monitor CVD risk factors like your blood pressure and cholesterol at home. But first, we want to help them understand your opinions. We want to hear about your experiences of managing your diabetes and whether you think these new tools would be useful.

When?
If you manage your diabetes with tablets: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Or
If you manage your diabetes with insulin: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Where? xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

NHS Diabetes is the essential link between diabetes strategy and frontline improvements for patients. They work with the Department of Health to provide national leadership and direction as well as support to local organisations working to champion excellent diabetes care.

Best wishes,
Katie

Katie Wilson
User Involvement Projects Officer
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


http://www.diabetes.org.uk/Get_involved ... es-Voices/



I have removed details of where and when for this meeting and Katie's contact details as this is an open forum but have instead inserted the web address for Diabetes Voices so if you feel you would like to contribute then why not send an email asking for details of any upcoming events in your area :thumbup:

 

[viviennem]

Good idea, Sid. Thanks.

Viv 8)

 

[ladybird64]

Yes, ladybird did attend one - details and feedback here. viewtopic.php?f=32&t=27755

I too have received the same email Sid and if truth be told, I am slightly torn. I do not feel that I "manage" my diabetes with tablets but with dietary control and have done since diagnosis. At present I am not taking any meds for the diabetes and have given this as my reason for non-attendance to Katie which it is, partially.
The other reason is that I feel that those who us who choose to manage by diet only are discounted and that is blatantly wrong, unfortunately it seems to be an all too common trend. I may actually drop a line to katie to find out why only those who prescription meds are invited to take part.

I thoroughly enjoyed my time at the session in South London but find it difficult to accept the apparent lack of interest in dietary issues from DUK and this continues to be the stumbling block for me and is why I have not taken up the offer of joining the "Voices". I have also had personal issues going on which has meant my time was taken up with other matters.

It is something I need to give some thought to. I do believe that there is no point protesting about lack of change if one is not prepared to become involved in fighting for that change..so at some point will probably get more involved.